Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents

Abstract

Studies have produced conflicting results of the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus-associated cirrhosis treated with direct-acting antivirals (DAAs). Data from clinics are needed to accurately assess the occurrence rate of HCC in patients with cirrhosis in the real world. We collected data from a large prospective study of 2,249 consecutive patients (mean age= 65.4 years, 56.9% male) with hepatitis C virus-associated cirrhosis (90.5% with Child-Pugh class A and 9.5% with Child-Pugh class B) treated with DAAs from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy. HCC occurrence was evaluated by Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with HCC development. A sustained virologic response (SVR) was achieved by 2,140 patients (total= 95.2%; 95.9% with Child Pugh class A and 88.3% with Child Pugh class B; P < .001). Seventy-eight patients (3.5%) developed HCC during a mean follow-up of 14 months (range= 6-24 months). At 1 year after exposure to DAAs, HCC developed in 2.1% of patients with Child-Pugh class A with an SVR and 6.6% of patients with no SVR and in 7.8% of patients with Child-Pugh class B with an SVR and 12.4% of patients with no SVR (P < .001 by log-rank test). Albumin level below 3.5 g/dL (hazard ratio= 1.77, 95% confidence interval= 1.12-2.82, P= .015), platelet count below 120× 109/L (hazard ratio= 3.89, 95% confidence interval= 2.11-7.15, P < .001), and absence of an SVR (hazard ratio= 3.40, 95% confidence interval= 1.89-6.12, P < .001) were independently associated increased risk for HCC. The mean interval from exposure to DAAs to an HCC diagnosis was 9.8 months (range= 2-22 months) and did not differ significantly between patients with (n= 64, 9.2 months) and without (n= 14, 12.0 months) an SVR (P= .11). A larger proportion of patients with an SVR had a single HCC lesion (78% vs 50% without an SVR; P= .009) or an HCC lesion smaller than 3 cm (58% vs 28% without an SVR; P= .07). In an analysis of data from a large prospective study of patients with hepatitis C virus-associated compensated or decompensated cirrhosis, we found that the SVR to DAA treatment decreased the incidence of HCC over a mean follow-up of 14 months.